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An Update on Combination Treatments with Fractional Resurfacing Lasers

  • Laser Therapy (J Jagdeo, Section Editor)
  • Published:
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Abstract

Purpose of the Review

This article serves to review the newest combination approaches of fractionated resurfacing lasers with other treatment modalities and highlights our clinical pearls.

Recent Findings

Combination therapies with fractionated lasers include treatments with transdermal drug delivery, radiofrequency, light-based devices, photodynamic therapy, and transdermal acoustic pressure.

Summary

Fractional resurfacing lasers revolutionized the laser skin resurfacing surgery by offering similar clinical outcomes to ablative lasers with fewer side effects and less post-treatment downtime. Fractionated lasers are the pillar of skin resurfacing treatments for photodamaged skin such as rhytides, lentigines, and dermal elastosis, actinic damage, and other dermatologic conditions, including acne, rosacea, and scars.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34(5):426–38. One of the first papers to describe fractional photothermolysis and mechanism of action.

    Article  PubMed  Google Scholar 

  2. Nino M, Calabrò G, Santoianni P. Topical delivery of active principles: the field of dermatological research. Dermatol Online J. 2010;16(1):4.

    PubMed  Google Scholar 

  3. Potts RO, Francoeur ML. The influence of stratum corneum morphology on water permeability. J Invest Dermatol. 1991;96(4):495–9.

    Article  CAS  PubMed  Google Scholar 

  4. Elias PM, Menon GK. Structural and lipid biochemical correlates of the epidermal permeability barrier. Adv Lipid Res. 1991;24:1–26.

    CAS  PubMed  Google Scholar 

  5. Hantash BM, Bedi VP, Kapadia B, Rahman Z, Jiang K, Tanner H, et al. In vivo histological evaluation of a novel ablative fractional resurfacing device. Lasers Surg Med. 2007;39(2):96–107.

    Article  PubMed  Google Scholar 

  6. Tannous Z. Fractional resurfacing. Clin Dermatol. 2007;25(5):480–6.

    Article  PubMed  Google Scholar 

  7. Waibel J, Beer K, Narurkar V, Alster T. Preliminary observations on fractional ablative resurfacing devices: clinical impressions. J Drugs Dermatol JDD. 2009;8(5):481–5.

    PubMed  Google Scholar 

  8. Brisson P. Percutaneous absorption. Can Med Assoc J. 1974;110(10):1182–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Haedersdal M, Sakamoto FH, Farinelli WA, Doukas AG, Tam J, Anderson RR. Fractional CO(2) laser-assisted drug delivery. Lasers Surg Med. 2010;42(2):113–22. Early study demonstrating enhanced delivery and uptake of methyl 5-aminolevulinate (MAL) as a test drug, creating a foundation of future laser-assisted drug delivery applications for other topical medications.

    Article  PubMed  Google Scholar 

  10. Waibel JS, Rudnick A, Nousari C, Bhanusali DG. Fractional ablative laser followed by transdermal acoustic pressure wave device to enhance the drug delivery of aminolevulinic acid: in vivo fluorescence microscopy study. J Drugs Dermatol JDD. 2016;15(1):14–21.

    CAS  PubMed  Google Scholar 

  11. Park JM, Jeong K-H, Bae MI, Lee S-J, Kim N-I, Shin MK. Fractional radiofrequency combined with sonophoresis to facilitate skin penetration of 5-aminolevulinic acid. Lasers Med Sci. 2016;31(1):113–8.

    Article  PubMed  Google Scholar 

  12. Marmur ES, Schmults CD, Goldberg DJ. A review of laser and photodynamic therapy for the treatment of nonmelanoma skin cancer. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2004;30(2 Pt 2):264–71.

    Google Scholar 

  13. Morton CA, McKenna KE, Rhodes LE, British Association of Dermatologists Therapy Guidelines and Audit Subcommittee and the British Photodermatology Group. Guidelines for topical photodynamic therapy: update. Br J Dermatol. 2008;159(6):1245–66.

    Article  CAS  PubMed  Google Scholar 

  14. Braathen LR, Szeimies R-M, Basset-Seguin N, Bissonnette R, Foley P, Pariser D, et al. Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus. International Society for Photodynamic Therapy in Dermatology, 2005. J Am Acad Dermatol. 2007;56(1):125–43.

    Article  PubMed  Google Scholar 

  15. Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med. 2013;45(3):135–40.

    Article  PubMed  Google Scholar 

  16. Cavalié M, Sillard L, Montaudié H, Bahadoran P, Lacour J-P, Passeron T. Treatment of keloids with laser-assisted topical steroid delivery: a retrospective study of 23 cases. Dermatol Ther. 2015;28(2):74–8.

    Article  PubMed  Google Scholar 

  17. Babilas P, Schreml S, Szeimies R-M, Landthaler M. Intense pulsed light (IPL): a review. Lasers Surg Med. 2010;42(2):93–104.

    Article  PubMed  Google Scholar 

  18. Haedersdal M, Katsnelson J, Sakamoto FH, Farinelli WA, Doukas AG, Tam J, et al. Enhanced uptake and photoactivation of topical methyl aminolevulinate after fractional CO2 laser pretreatment. Lasers Surg Med. 2011;43(8):804–13.

    Article  CAS  PubMed  Google Scholar 

  19. Haedersdal M, Sakamoto FH, Farinelli WA, Doukas AG, Tam J, Anderson RR. Pretreatment with ablative fractional laser changes kinetics and biodistribution of topical 5-aminolevulinic acid (ALA) and methyl aminolevulinate (MAL). Lasers Surg Med. 2014;46(6):462–9.

    Article  PubMed  Google Scholar 

  20. Togsverd-Bo K, Haak CS, Thaysen-Petersen D, Wulf HC, Anderson RR, Hædersdal M, et al. Intensified photodynamic therapy of actinic keratoses with fractional CO2 laser: a randomized clinical trial. Br J Dermatol. 2012;166(6):1262–9.

    Article  CAS  PubMed  Google Scholar 

  21. Helsing P, Togsverd-Bo K, Veierød MB, Mørk G, Haedersdal M. Intensified fractional CO2 laser-assisted photodynamic therapy vs. laser alone for organ transplant recipients with multiple actinic keratoses and wart-like lesions: a randomized half-side comparative trial on dorsal hands. Br J Dermatol. 2013;169(5):1087–92.

    Article  CAS  PubMed  Google Scholar 

  22. KE Karmisholt, M Haedersdal. Ablative fractional laser intensifies treatment outcome of scalp actinic keratoses with ingenol mebutate: a case report. J Eur Acad Dermatol Venereol. p. n/a–n/a, 2015.

  23. Alexiades-Armenakas M. Laser-mediated photodynamic therapy. Clin Dermatol. 2006;24(1):16–25.

    Article  PubMed  Google Scholar 

  24. Sotiriou E, Apalla Z, Chovarda E, Panagiotidou D, Ioannides D. Photodynamic therapy with 5-aminolevulinic acid in actinic cheilitis: an 18-month clinical and histological follow-up. J Eur Acad Dermatol Venereol JEADV. 2010;24(8):916–20.

    Article  CAS  PubMed  Google Scholar 

  25. Choi SH, Kim KH, Song K-H. Efficacy of ablative fractional laser-assisted photodynamic therapy for the treatment of actinic cheilitis: 12-month follow-up results of a prospective, randomized, comparative trial. Br J Dermatol. 2015;173(1):184–91.

    Article  CAS  PubMed  Google Scholar 

  26. Nguyen BT, Gan SD, Konnikov N, Liang CA. Treatment of superficial basal cell carcinoma and squamous cell carcinoma in situ on the trunk and extremities with ablative fractional laser-assisted delivery of topical fluorouracil. J Am Acad Dermatol. 2015;72(3):558–60.

    Article  PubMed  Google Scholar 

  27. Ko DY, Kim KH, Song KH. A randomized trial comparing methyl aminolaevulinate photodynamic therapy with and without Er:YAG ablative fractional laser treatment in Asian patients with lower extremity Bowen disease: results from a 12-month follow-up. Br J Dermatol. 2014;170(1):165–72.

    Article  CAS  PubMed  Google Scholar 

  28. Avram MM, Tope WD, Yu T, Szachowicz E, Nelson JS. Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing. Lasers Surg Med. 2009;41(3):185–8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Monstrey S, Middelkoop E, Vranckx JJ, Bassetto F, Ziegler UE, Meaume S, et al. Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstr Aesthetic Surg JPRAS. 2014;67(8):1017–25.

    Article  PubMed  Google Scholar 

  30. Sklar LR, Burnett CT, Waibel JS, Moy RL, Ozog DM. Laser assisted drug delivery: a review of an evolving technology. Lasers Surg Med. 2014;46(4):249–62. Comprehensive review that offers clinical applications of laser-assisted drug delivery.

    Article  PubMed  Google Scholar 

  31. Butterwick K, Lowe NJ. Injectable poly-L-lactic acid for cosmetic enhancement: learning from the European experience. J Am Acad Dermatol. 2009;61(2):281–93.

    Article  CAS  PubMed  Google Scholar 

  32. Waibel J, Beer K. Ablative fractional laser resurfacing for the treatment of a third-degree burn. J Drugs Dermatol JDD. 2009;8(3):294–7.

    PubMed  Google Scholar 

  33. Kates LC, Fitzgerald R. Poly-L-lactic acid injection for HIV-associated facial lipoatrophy: treatment principles, case studies, and literature review. Aesthetic Surg J Am Soc Aesthetic Plast Surg. 2008;28(4):397–403.

    Article  Google Scholar 

  34. Rkein A, Ozog D, Waibel JS. Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid. Dermatol Surg Off Publ Am Soc Dermatol Surg Al. 2014;40(6):624–31.

    CAS  Google Scholar 

  35. Wang L, Tai N-Z, Fan Z-H. Effect of botulinum toxin type A injection on hypertrophic scar in rabbit ear model. Zhonghua Zheng Xing Wai Ke Za Zhi Zhonghua Zhengxing Waike Zazhi Chin J Plast Surg. 2009;25(4):284–7.

    CAS  Google Scholar 

  36. M Chen, T Yan, K Ma, L Lai, C Liu, L Liang, X Fu. Botulinum toxin type a inhibits α-smooth muscle actin and myosin II expression in fibroblasts derived from scar contracture. Ann Plast Surg. 2014.

  37. Shaarawy E, Hegazy RA, Abdel Hay RM. Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: a randomized controlled trial. J Cosmet Dermatol. 2015;14(2):161–6.

    Article  PubMed  Google Scholar 

  38. Beer K, Waibel J. Botulinum toxin type A enhances the outcome of fractional resurfacing of the cheek. J Drugs Dermatol JDD. 2007;6(11):1151–2.

    PubMed  Google Scholar 

  39. Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009;60(5 Suppl):S1–S50.

    Article  PubMed  Google Scholar 

  40. Whitney KM, Ditre CM. Management strategies for acne vulgaris. Clin Cosmet Investig Dermatol. 2011;4:41–53.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Barolet D, Boucher A. Radiant near infrared light emitting Diode exposure as skin preparation to enhance photodynamic therapy inflammatory type acne treatment outcome. Lasers Surg Med. 2010;42(2):171–8.

    Article  PubMed  Google Scholar 

  42. Wiegell SR, Wulf HC. Photodynamic therapy of acne vulgaris using 5-aminolevulinic acid versus methyl aminolevulinate. J Am Acad Dermatol. 2006;54(4):647–51.

    Article  PubMed  Google Scholar 

  43. Orringer JS, Sachs DL, Bailey E, Kang S, Hamilton T, Voorhees JJ. Photodynamic therapy for acne vulgaris: a randomized, controlled, split-face clinical trial of topical aminolevulinic acid and pulsed dye laser therapy. J Cosmet Dermatol. 2010;9(1):28–34.

    Article  PubMed  Google Scholar 

  44. Wiegell SR, Wulf HC. Photodynamic therapy of acne vulgaris using methyl aminolaevulinate: a blinded, randomized, controlled trial. Br J Dermatol. 2006;154(5):969–76.

    Article  CAS  PubMed  Google Scholar 

  45. Yeung CK, Shek SY, Bjerring P, Yu CS, Kono T, Chan HH. A comparative study of intense pulsed light alone and its combination with photodynamic therapy for the treatment of facial acne in Asian skin. Lasers Surg Med. 2007;39(1):1–6.

    Article  PubMed  Google Scholar 

  46. Gürbüz A, Özhan G, Güngör S, Erdal MS. Colloidal carriers of isotretinoin for topical acne treatment: skin uptake, ATR-FTIR and in vitro cytotoxicity studies. Arch Dermatol Res. 2015;307(7):607–15.

    Article  PubMed  Google Scholar 

  47. Dahan S. Laser and intense pulsed light management of couperose and rosacea. Ann Dermatol Vénéréologie. 2011;138 Suppl 3:S219–22.

    Article  Google Scholar 

  48. Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol. 2008;58(5):719–37. quiz 738–740.

    Article  PubMed  Google Scholar 

  49. Narurkar VA. Nonablative fractional laser resurfacing. Dermatol Clin. 2009;27(4):473–8. vi.

    Article  CAS  PubMed  Google Scholar 

  50. Booth BA, Uitto J. Collagen biosynthesis by human skin fibroblasts. III. The effects of ascorbic acid on procollagen production and prolyl hydroxylase activity. Biochim Biophys Acta. 1981;675(1):117–22.

    Article  CAS  PubMed  Google Scholar 

  51. Lin F-H, Lin J-Y, Gupta RD, Tournas JA, Burch JA, Selim MA, et al. Ferulic acid stabilizes a solution of vitamins C and E and doubles its photoprotection of skin. J Invest Dermatol. 2005;125(4):826–32.

    Article  CAS  PubMed  Google Scholar 

  52. S Waibel, Q-S Mi, D Ozog, L Qu, L Zhou, A Rudnick, F Al-Niaimi, J Woodward, V Campos, S Mordon. Laser-assisted delivery of vitamin C, vitamin E, and ferulic acid formula serum decreases fractional laser postoperative recovery by increased beta fibroblast growth factor expression. Lasers Surg Med. 2015.

  53. Kim H, Gallo J. Evaluation of the effect of platelet-rich plasma on recovery after ablative fractional photothermolysis. JAMA Facial Plast Surg. 2015;17(2):97–102.

    Article  PubMed  Google Scholar 

  54. Tao L, Wu J, Qian H, Lu Z, Li Y, Wang W, et al. Intense pulsed light, near infrared pulsed light, and fractional laser combination therapy for skin rejuvenation in Asian subjects: a prospective multi-center study in China. Lasers Med Sci. 2015;30(7):1977–83.

    Article  PubMed  Google Scholar 

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Correspondence to Melissa Kanchanapoomi Levin.

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Conflict of Interest

Dr. Ellen S. Marmur is a principal investigator for Galderma, and Dr. Melissa K. Levin is a sub-investigator for Galderma, outside of the submitted work. Dr. Ellen Marmur is on the advisory board for Sciton and Solta Medical, Division of Valeant Pharmaceuticals, outside of the submitted work. Ms. Margit Lai Wun Juhasz declares no relevant conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Laser Therapy

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Levin, M.K., Juhasz, M.L.W. & Marmur, E.S. An Update on Combination Treatments with Fractional Resurfacing Lasers. Curr Derm Rep 5, 191–199 (2016). https://doi.org/10.1007/s13671-016-0145-6

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